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FOR OFFICE USE: � 7�G. ............................. ..................�.: --•APPLICATION 1=0R SANITATION'PERMIT Permit No. - 1 _ - _�•_.. G�'+ {Complete In,Triplicate! --A _ a ..................................... , TR This Permit Expires 1 Year From Onto Iseued Dote lssued /� Application is hereby made to the San Joaquin Local Health District f6f 6 permit to construct-andinstall the 'Work herein described. This application is made in complion a with ty Ordinance No. 549 and existing Rules and Regulations: JOS ADDRESS/LOCATI ?L / ../..!!..t----• �b �1 Gl.. CENSUS TRACT ............... .................... Owner's Name-------- •.... _ ...._ Phone ........ ...... Address `'A,;�4 -7 : 1 -------•------.-- City `f-�-.•• --. •--- - - rContractor's Name .._ License1 _.. PhoneJ..____..;:. '.-- Installation will serve: Residencepartment Housefl Commercial OTraller Court 0 Motel [3 Other..................-......................... g g . Lot Size ..�b._. , , d ' Number of living units: Number of rooms ..��Garba a Grinder . ........... . v Water Supply: Public System and name 's 1 ......... .......................................................private � Character of soil ton depth of 3 feet. 'Sand o Silt o Clay Peat❑ Sandy Loam CJ Clay Loam t3 � Hardpan Q Adobe ill Material ............ If yes,type............... (Plot .plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage 'if permitted if ublic-sewer:is available within 200-feet,) PACKAGE TREATMENT j ] SEPTIC TAMC I f, a .t Si e. -._ �.1. .. Liquid Depth .. �,.......,.... Capacity ----- _ ._ Type s��. Materia) No. Compartments ._':Z... istance.to nearest: Well _..._��,� ....Foundation 1A..... Prop. Line ... ;......... g .... Total Length LEACHING LINT: No, of Lines " ..... Length of each line_._....�.+�.__...... - ' 'D' 8ox"'..-----... Type Filter Material r.0_54......Depth Filter Material .... . ................................... l r ....... . Foundation _.. .:.. + Distance to nearest: Well ......,!l1. - -------- Property line _.. �............. SEEPAGE PIT Depth . ....... Diameter ----- Number ---_---_-_-.�....:.._... Rock Filled Yes np—No C3 � 3 Water Table Depth .............T.-GG....----................Rock Size .....-r�� X--------------- 'Distance to nearest: Well ..... ...............Faundatlorr: ...... Prop. tine ..>5 ............... REPAIR/ADDITION{Prey. Sanitation Permit ...... Date `"'" '" "" l ` Septic Tank (Specify Requirements) --------------• ---...:•.......-•---.....----:......_._....._.........._..._..................... Disposal Field (Specify Requirementsl ----------- -- .................. ......................--.................................. ..•------ ---------•----• 1 ----------------------- ----------- --•-•-- - -----------_ -------------- -•------------------------•----------•-••-.._.........---........._.-....-............................... } (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Home owner or licen- sed agents signature certifies the following: _ "I certify that In the performance of the work for which this permit is issued, 1 shall not employ any person in such manner, as to become subject to Workman's Compensation laws of California," ? Signed ----------------------- --------------_- ---- .. _--- Owner s ------- Title '�. �..... ............... (if oth t an owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- .•- „�iL ............:.......... DATE .r,._. --'--7- .--- ----------- BUILDING PERMIT ISSUED ... -----------------------.---DATE ........ •--•------- •--•-_---- ADDITIONALCOMMENTS ------------------- -------•--------------------_----- ----•----•---- ..........-.............. _...._... ......... 4 ------------------------•--------------- '` - Final inspection by: .,<�:. ---_Hate. ............... ...... .----- EH 13 2h 1-65 ` i 'v.�5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M